James is 25 years old and in good health. He has been in a committed relationship for the past four years. He loves his partner, and they intend to start a family. However, James has been struggling with erectile dysfunction. He has undergone a full physical exam, and so far, no treatable cause has been identified.
Dealing with erectile dysfunction has been a stressful experience for both James and his partner. Like most young men, James believed erectile dysfunction was only a problem for the elderly and those with chronic diseases. Unfortunately, erectile dysfunction can impact men and their relationships at any age, including in their 20s and 30s.
Erectile dysfunction can be a sensitive subject to broach. However, as with any medical issue, it is essential to fully understand what causes erectile dysfunction in young men and review the available treatment options.
In This Article
Erectile dysfunction (ED) is defined as the inability to obtain and maintain an erection suitable for sexual intercourse. Being receptive to sexual stimulation is the first step toward achieving an erection. Hormones, such as testosterone, must be at optimal levels for the message to be transmitted from the brain to the penis.
Once this occurs, blood flow increases into the corpus cavernosum of the penis, causing pressure to rise and an erection. This process may appear simple, but problems with the circulatory or nervous system can easily prevent it from taking place.
The short answer is that it is more common than you might think. One in every four men with newly diagnosed erectile dysfunction is under the age of 40. Almost half of the men in the study were in their twenties and thirties and had severe ED, defined as the inability to maintain a firm enough erection for penetrative sex.
When compared to older men with ED, young men with ED had a lower rate of comorbid medical conditions, a lower body mass index, and a higher mean circulating testosterone level. Furthermore, younger men with ED smoked cigarettes and used illicit drugs more frequently than older men with ED.
Another study involving 27,000 men from eight countries found that the prevalence of ED was 8% in men between the ages of 20 and 29 and 11% in men between the ages of 30 and 39.
When looking at a graph that shows the prevalence of men in their 20s and 30s seeking treatment between 2010 and 2015, you can’t help but notice the percentage tripled in those five years.
Prior to the 1970s, men in their 20s and 30s with ED were believed to have a psychogenic origin to their symptoms. However, newer research indicates that up to 87% of men under the age of 40 with ED have a physical component to their condition. Because of the complex interplay between physiology and psychology involved in obtaining and maintaining an erection, the cause of ED is frequently a combination of factors.
More men under the age of 40 are being diagnosed with ED and treated. Understanding the causes of ED can make it far easier to treat.
In most cases, it is highly unlikely that a single cause of ED will be found.
Having a gradual onset of symptoms and a healthy libido are more commonly associated with a physical cause of ED.
While a sudden onset of symptoms, intermittent function, a decreased libido, and good quality spontaneous or self-stimulated erections are more characteristic of psychogenic causes.
It is important to think of the causes of ED as more of a spectrum ranging from purely psychological to purely physical, with the majority of cases falling somewhere in between.
The physical causes of ED may include the following:
Nerve damage or malfunction:
Blood vessel disease:
The complex process of achieving an erection begins in the brain. Conditions that change the levels of neurotransmitters (messengers) in the brain can interfere with this process. Examples include:
The first step in treating ED is determining the cause. Your doctor will take a medical, sexual, and psychosocial history and do a complete physical exam. This is often all that is required to make a diagnosis and discuss potential treatment options.
If your symptoms point to a medical cause of ED, further lab work or testing may be ordered. ED can be a marker for underlying cardiovascular disease and other health conditions.
Blood vessel damage and changes in blood flow are two of the most common organic contributors to ED. Blood vessels are tiny tubes through which blood flows. When the smooth muscle around these tubes spasm, blood flow decreases. Smoking and nicotine, as well as some medications, are vasoconstrictors, which means they cause these muscles to contract and slow blood flow into the penis.
Diets high in saturated and trans-fat can increase your levels of low-density lipoproteins (LDL, bad cholesterol). This cholesterol accumulates on the inner lining of blood vessels, narrowing their lumen and reducing blood flow. Making time for regular physical activity, following a healthy diet, such as the Mediterranean diet, and decreasing or quitting alcohol and nicotine use can all lead to improved blood vessel function.
Maintaining a healthy weight is important for lowering the risk of ED in young men and improving symptoms if ED is already a problem. Increased body mass index, a high waist circumference, and low levels of physical activity have all been linked to an increased risk of ED.
“Men should be informed of all treatment options that are not medically contraindicated and supported in the shared decision-making process to determine the appropriate treatment (for ED). Although many men may choose to begin with the least invasive options (i.e., oral medications), the panel notes that it is valid for men to begin with any type of treatment, regardless of invasiveness or reversibility.” American Urological Association
There are many treatment options for ED, and as stated by the American Urological Association, men should be offered the full range of treatments.
Oral phosphodiesterase type 5 (PDE5) inhibitors such as Viagra, Cialis, Stendra, and Levitra: PDE5 is an enzyme that increases nitric oxide levels. Nitric oxide dilates blood vessels allowing more blood to flow into the penis. PDE5 inhibitors maintain high nitric oxide levels and blood flow into the penis.
Suppositories: Prostaglandin E1 (alprostadil) is available as a suppository.
Testosterone replacement therapy: Testosterone replacement therapy is recommended for men with hypogonadism.
Injectables such as Trimix: Trimix injectables comprise three different medications—phentolamine, papaverine, and alprostadil. These medications work together to improve blood flow into the penis.
Vacuum erection devices: A cylinder is placed over the penis to create a vacuum and draw blood into the corpora cavernosum. A band is left at the base of the penis when the cylinder is removed. The band prevents blood from exiting the penis. The band must be removed within 30 minutes, or damage to the penis may occur.
Penile implants and other surgical options: Men might consider having an internal penile pump (IPP) implanted when other treatment options have been exhausted.
Since the etiology of ED is frequently multifactorial, your doctor may suggest a referral to a mental health specialist to work on psychological causes of ED through therapy, medication, or a combination of both.
Lifestyle changes can improve overall health and also improve the symptoms of ED.
ED can be a difficult topic for men to discuss with their partners and healthcare providers. However, being empowered with the knowledge that the condition affects men, both young and old, can make it less uncomfortable. ED treatment is multifaceted. Men can work on any modifiable risk factors that put them at increased risk for ED and explore the range of treatment options available.
While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.